The impact of new technologies to diagnose and treat periodontal disease. A look to the future

Host-derived salivary biomarkers may be useful in diagnosing periodontal disease

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Host-derived salivary biomarkers in diagnosing periodontal disease: systematic review and meta-analysis. de Lima CL, Acevedo AC, Grisl DC, Taba M Jr, Guerra E, De Luca Canto G. J Clin Periodontol 2016; 43(6): 492-502.

SOURCE OF FUNDING

Self-funded TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Evaluation of Some Microenvironmental Inflences on the Regenerative Mechanisms of the Periodontium: An in Vitro Study

Studies have demonstrated the chemotactic response of periodontal ligament cells to a wide range of matrix molecules and growth factors, suggesting a therapeutic role for the latter in tissue lesion restoration. Impaired human gingival and periodontal ligament fibroblasts from adult donors were stimulated in vitro with growth factors or grown on a biosynthetic tissue-guiding membrane in the presence of tetracycline (minocycline) to assess the effects of these molecules on cell proliferation and tolerance to the drug. The results suggest that techniques involving tissue-guiding membranes and growth factors associated with inhibitors of collagenases constitute a promising biological-like way of restoring the delicate equilibrium disrupted by periodontal disease.

Elastase and metalloproteinase-9 concentrations in saliva in patients with chronic periodontitis

Elastase and metalloproteinase-9 (MMP-9) are two of numerous proteolytic enzymes released by neutrophilic granulocytes in the course of periodontitis. The aim of the study was to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis compared to healthy individuals.

The enzyme-linked immunosorbent assay method was employed to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis and with pocket depth (PD) ≥ 6 mm and PD < 6 mm, as well as in saliva of healthy individuals. Significantly higher concentrations of elastase and MMP-9 were observed in patients with periodontitis compared to healthy individuals (p < 0.01). Also a significant difference in elastase concentration in saliva was observed between the PD ≥ 4 mm and PD < 6 mm groups and between the PD ≥ 6 mm and control groups, and statistically significant differences in MMP-9 concentrations between the PD ≥ 6 mm and control groups. No statistically significant differences were observed between the PD < 6 mm and control groups for elastase concentrations in saliva as well as between the PD ≥ 6 mm and PD < 6 mm groups, and also between the PD < 6 mm and control groups for MMP-9 concentrations in saliva. Elastase and MMP-9 concentrations in saliva can be considered as biochemical indicators of severity of periodontitis.

Periodontal disease immunology: 'double indemnity' in protecting the host

During the last two to three decades our understanding of the immunobiology of periodontal disease has increased exponentially, both with respect to the microbial agents triggering the disease process and the molecular mechanisms of the host engagement maintaining homeostasis or leading to collateral tissue damage. These foundational scientific findings have laid the groundwork for translating cell phenotype, receptor engagement, intracellular signaling pathways and effector functions into a 'picture' of the periodontium as the host responds to the 'danger signals' of the microbial ecology to maintain homeostasis or succumb to a disease process. These findings implicate the chronicity of the local response in attempting to manage the microbial challenge, creating a 'Double Indemnity' in some patients that does not 'insure' health for the periodontium. As importantly, in reflecting the title of this volume of Periodontology 2000, this review attempts to inform the community of how the science of periodontal immunology gestated, how continual probing of the biology of the disease has led to an evolution in our knowledge base and how more recent studies in the postgenomic era are revolutionizing our understanding of disease initiation, progression and resolution. Thus, there has been substantial progress in our understanding of the molecular mechanisms of host-bacteria interactions that result in the clinical presentation and outcomes of destructive periodontitis. The science has embarked from observations of variations in responses related to disease expression with a focus for utilization of the responses in diagnosis and therapeutic outcomes, to current investigations using cutting-edge fundamental biological processes to attempt to model the initiation and progression of soft- and hard-tissue destruction of the periodontium. As importantly, the next era in the immunobiology of periodontal disease will need to engage more sophisticated experimental designs for clinical studies to enable robust translation of basic biologic processes that are in action early in the transition from health to disease, those which stimulate microenvironmental changes that select for a more pathogenic microbial ecology and those that represent a rebalancing of the complex host responses and a resolution of inflammatory tissue destruction.

Modulation of host cell signaling pathways as a therapeutic approach in periodontal disease

Recently, new treatment approaches have been developed to target the host component of periodontal disease. This review aims at providing updated information on host-modulating therapies, focusing on treatment strategies for inhibiting signal transduction pathways involved in inflammation. Pharmacological inhibitors of MAPK, NFκB and JAK/STAT pathways are being developed to manage rheumatoid arthritis, periodontal disease and other inflammatory diseases. Through these agents, inflammatory mediators can be inhibited at cell signaling level, interfering on transcription factors activation and inflammatory gene expression. Although these drugs offer great potential to modulate host response, their main limitations are lack of specificity and developments of side effects. After overcoming these limitations, adjunctive host modulating drugs will provide new therapeutic strategies for periodontal treatment.

Awareness of periodontal disease--the role of industry

Recently periodontal treatments have been performed intensively in daily clinical work and the definitive approach to periodontal therapy has been established in various types of periodontal diseases. It is no exaggeration to say that this is impossible without the co-operation of the dental industry. Furthermore, industry has also contributed greatly to the improvement of the 'quality of life', concerning masticatory function in the elderly. Both the progression of dental devices and the development of diagnostic methods have been considered to be the primary prerequisite for success in treatment and in the prevention of recurrence of the periodontal diseases. It is necessary that dental devices and medications for treatment should be developed corresponding to the advanced scientific evaluation of periodontal disease. This paper reviews our present knowledge about the role or contribution of industry to periodontology in terms of periodontal health care products, diagnostic kits, and therapeutic drugs.

The optimization of the BANA test as a screening instrument for gingivitis among subjects seeking dental treatment

Porphyromonas gingivalis, Treponema denticola and Bacteroides forsythus have been implicated in periodontal disease and each possesses an enzyme capable of hydrolyzing the synthetic trypsin substrate, BANA. We have used a chairside test for BANA hydrolysis to diagnose an anaerobic periodontal infection in patients with advanced forms of clinical disease using a 15-min/55 degrees C incubation protocol. However, the BANA test performance is dependent upon the length and temperature of incubation. In the present study, we have evaluated a 5-min/35 degrees C, a 5-min/55 degrees C and a 15-min/55 degrees C incubation protocol to determine whether the performance of the BANA test could be optimized using plaque samples obtained from subjects seeking dental treatment. Logistic regression models were tested with age, smoking status, and gingivitis scores as covariates. The best fitting model obtained with the 5-min/35 degrees C protocol had a sensitivity of 71%, a specificity of 68%, a false-positive proportion of 9%, a false-negative proportion of 65%, and an overall accuracy of 80%. When maximum likelihood estimates were obtained in this model, plaques from individuals who reported that they currently smoked were 9.57x, and those who quit smoking were 4.73x more likely to have a positive BANA score than someone who never smoked. Plaques were 4.55x more likely to be BANA-positive if they were removed from sites with gingivitis. These findings indicate that the performance of the BANA test is best using the 5-min/35 degrees C incubation protocol.